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Individual

CHARLES A MUSGRAVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2570 NW EDENBOWER BLVD, SUITE 100, ROSEBURG, OR 97471-6214
(541) 957-1111
(541) 957-5705
Mailing address
PO BOX 1247, 2570 NW EDENBOWER BLVD SUITE 100, ROSEBURG, OR 97470-0310
(541) 957-1111
(541) 957-5705

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00770
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0202220
IND INDUSTRIAL WA STATE
WA
01
J406426
IND PACSOURCE
OR
Enumeration date
02/08/2006
Last updated
01/28/2010
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